In vitro fertilization is a group of methods for the fertilization of the oocyte (egg) with the partner’s sperm or an anonymous donor’s sperm outside the female body. In the subsequent joint cultivation of sperm and eggs, fertilization occurs as in spontaneous pregnancy and therefore proper sperm selection is in the hands of nature. The fertilised eggs remain in the incubator until embryo transfer, normally 3-5 days. It is a fundamental method used in reproductive medicine.
The initial consultation is non-binding and free at our clinic. It is enough just to call/email us and make an appointment – you do not need a gynaecologist’s, or urologist’s recommendation or any results. With your doctor, you will discuss your health and he/she will suggest possible examinations and treatment options.
You will come to the first consultation together with your partner. After a thorough analysis of both partners’ medical histories, we will continue with an ultrasound and a vaginal examination of the female partner and usually the partner’s spermiogram. After evaluating the input information with the doctor and IVF specialist, an individual treatment strategy is proposed.
In most cases, the probable cause of infertility can be determined by means of specialized examinations. However, 15% of the cases remain unexplained; this is the so-called idiopathic sterility. The traditional claim about infertility among couple is that in 30% of cases, it is both the woman’s and the man’s fault. However, this ceases to be true because currently the number of men with fertility problems is increasing at an unusual rate. Very often, unfortunately, we encounter cases of combined sterility (up to 20 percent of the cases) when a disorder occurs in both partners.
Infertility diagnosis examinations are focused on assessing of ovarian activity, tubal patency, hormone levels, sperm production in men, immunology in both partners, genetic findings and haematology.
This examination informs us about the condition of the female’s reproductive system, the status of the ovaries, and especially the so-called ovarian reserve, which is the ability to produce eggs and their indicative quantity in the ovary.
FSH (follicle stimulating hormone) 1.9 – 12 IU/ml
LH (luteinizing hormone) 0.9-12 IU/ml
PRL (prolactin) of less than 25 ng/ml
TSH (thyroid stimulating hormone) 1.0 – 4.0 IU/ml
AMH (antimullerian hormone) 0.5 – 30 IU/ml (depending on age)
Ultrasound examination consists mostly of transvaginal examination of the uterus and the ovaries. We focus on the size and the shape of the uterus, the height and structure of the uterine mucosa and its possible pathologies – polyps and myomatous nodes. An ultrasound examination of the ovaries is important from the point of view of checking and excluding the presence of cysts and estimating the ovarian reserve, thus the strength of the ovaries.
The tubal patency is decisive in the case of trying to achieve spontaneous conception. We investigate tubal patency with the most advanced and gentle methods for the woman at our clinic. It involves the administration of a special gel/foam through the uterine cervix while monitoring the passage of the contrast medium through the tubes via ultrasound. If you decide for this procedure under general anaesthesia, we supplement this examination with a so-called hysteroscopy – a uterine examination by camera/optics for detailed cervical imaging, the character of the mucous membrane, and the simultaneous surgical removal of minor pathologies such as polyps or small intracerebral growths, which can obstruct a successful pregnancy.
The aim of genetic consultation is therefore a karyotype examination, i.e. examination of the number of the partners’ chromosomes. It is indicated in case of repeated pregnancy losses, repeated unsuccessful IVF cycles and genetic load.
Your care is important for us; therefore, you are in close contact with doctors and IVF coordinators – you will always have the contact information of one doctor and one nurse, and in case of individual needs, we are permanently available.
Currently, we are increasingly experiencing male infertility, so we have expanded our spectrum of diagnostic and therapeutic procedures at our clinic.
The examination of the male begins with a spermiogram. In case of pathological values, we recommend a check-up spermiogram after a certain period of time. At the clinic, we have an andrologist who you can consult your findings with at any time. If a pathological spermiogram is repeated even after a certain period of time following an adjustment of nutrition and vitamin therapy, a urological examination is indicated. We work with renowned urologists who deal with male infertility.
This is done as an initial examination when investigating the causes of male infertility. Without the spermiogram results, it does not make sense to do a detailed examination for a female. At the ISCARE clinic, we evaluate the spermiogram according to the current World Health Organization criteria.
The sperm collection is performed in the sampling room by masturbation into a sterile sampling container. It is important to have a 2 to 5-day sexual abstinence. The test examines volume, quality, pH, liquefaction, quantity and shape of the sperm in the male ejaculate.
At the ISCARE clinic, we have a urologist who can do all the necessary examinations if necessary.
In certain indicated cases, such as very serious disorders in the sperm count and quality, it is necessary to investigate sperm using the FISH method, which examines the karyotype.
If all the examinations and results are fine, your doctor will prepare a stimulation protocol based on your results, and the whole process will be explained to you again. The purpose of the stimulation is to create several eggs in the ovaries that are subsequently removed and fertilized by the partner sperm at the time of their maturity.
During hormonal treatment, usually on day 5 to 6, you will come to the clinic for an ultrasound check-up, which we will use to monitor the progress of the stimulation and investigate the ovarian reaction. We monitor the number and the size of the follicles created (packs in which the egg is present) and also the structure and the height of the uterine mucosa. The doctor will determine the exact day and time of the egg collection, as well as the time of the last injection to ensure egg maturation, usually within 34-36 hours prior to the collection of the eggs based on ultrasound data.
The egg collection is performed under short-term general anaesthesia during a one-day surgery. The eggs are collected through the vagina using an ultrasonic probe which a special puncture needle is attached to. On this day, the male partner also hands over a sample of the ejaculate, which is then processed and used to fertilize the eggs obtained. Following the egg collection, the female remains in bed for about 2-3 hours. Subsequently, you and your partner will undergo an embryological interview where our experienced embryologists will thoroughly explain the fertilisation process, and on the basis of your medical history and examinations, they will propose further steps to maximize the success of the treatment. After being released from the clinic, the patient needs an escort since driving is not recommended and the patient should be monitored after receiving general anaesthesia.
IVF In vitro fertilization is fertilization of an egg outside the female body (artificial fertilisation). It is divided into ICSI and IVF methods.
This is the method where the sperm is introduced directly into the egg via a special glass pipette under the microscope. The embryologist selects the sperm under high magnification after assessing its morphological properties and on the basis of its motion. Subsequently the sperm is immobilized and injected into the mature egg. This method ensures a higher probability of fertilization. The success rate is between 70 and 80 percent. ICSI is used with various disorders of the sperm, for a female patient of advanced age (over 35), but also in case the stimulation results in formation of a lower number of oocytes.
It is a method where egg fertilization by the sperm takes place during their joint cultivation. A drop of ejaculate is dropped onto the egg and then the sperm penetrates into the egg. This is a more natural way of fertilisation, since sperm selection naturally occurs as in spontaneous fertilisation. The statistical success rate is 60%, and this method is suitable in case of a good spermiogram, for the first IVF cycle, and for example, if the cause of infertility is lack of tubal patency.
After the fertilisation with the partner’s or the donor’s sperm, the egg becomes an embryo. All embryos are then monitored in the embryological laboratory and transferred to the patient’s uterus usually on the fifth day. The transfer is performed using a special catheter under ultrasound control. The procedure is painless and usually does not last for more than a few minutes. Due to the high success rate of the treatment and the recommendation of the European Society for Reproductive Medicine (ESHRE), we prefer transferring only one embryo. A multiple pregnancy is considered a complication of treatment. It is of paramount importance for our patients to have an uncomplicated pregnancy after successful fertilisation and to give birth to a healthy baby on time – and a precise embryo transfer at our clinic is a start on this path.
If more than one quality embryo is available on the fifth day of cultivation, the embryo transfer will be followed by the process of freezing of the remaining embryos. Embryos are frozen using a cutting-edge method (vitrification). Such frozen embryos are stored and ready for use in the future. The freezing process is also an ideal option in case of the ovarian hyperstimulation syndrome and when embryo transfer is not recommended. The frozen embryo transfer is performed after a short drug preparation of the uterine mucosa or in the so-called native cycle, mostly between 17-22 days of the menstruation cycle. The success rate of frozen embryo transfer is the same as with embryo transfer and is currently about 45 %.
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